- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,366.00 / $11,282.10 / $15,607.50
| Facility | | $3,366.00 | $11,282.10 | $15,607.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,140.37
| Facility | | $1,146.00 | $3,000.00 | $5,140.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,246.43 / $5,867.27 / $10,882.95
| Facility | | $4,246.43 | $5,867.27 | $10,882.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,246.43 / $5,867.27 / $10,882.95
| Facility | | $4,246.43 | $5,867.27 | $10,882.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,164.04 / $7,509.55 / $11,643.67
| Facility | | $3,164.04 | $7,509.55 | $11,643.67 |